Automated Deep Learning Phenotyping of Tricuspid Regurgitation in Echocardiography

Importance Accurate assessment of tricuspid regurgitation (TR) is necessary for identification and risk stratification. Objective To design a deep learning computer vision workflow for identifying color Doppler echocardiogram videos and characterizing TR severity. Design, Setting, and Participants An automated deep learning workflow was developed using 47 312 studies (2 079 898 videos) from Cedars-Sinai Medical Center (CSMC) between 2011 and 2021. Data analysis was performed in 2024. The pipeline was tested on a temporally distinct test set of 2462 studies (108 138 videos) obtained in 2022 at CSMC and a geographically distinct cohort of 5549 studies (278 377 videos) from Stanford Healthcare (SHC). Training and validation cohorts contained data from 31 708 patients at CSMC receiving care between 2011 and 2021. Patients were chosen for parity across TR severity classes, with no exclusion criteria based on other clinical or demographic characteristics. The 2022 CSMC test cohort and SHC test cohorts contained studies from 2170 patients and 5014 patients, respectively. Exposure Deep learning computer vision model. Main Outcomes and Measures The main outcomes were area under the receiver operating characteristic curve (AUC), sensitivity, and specificity in identifying apical 4-chamber (A4C) videos with color Doppler across the tricuspid valve and AUC in identifying studies with moderate to severe or severe TR. Results In the CSMC test dataset, the view classifier demonstrated an AUC of 1.000 (95% CI, 0.999-1.000) and identified at least 1 A4C video with color Doppler across the tricuspid valve in 2410 of 2462 studies with a sensitivity of 0.975 (95% CI, 0.968-0.982) and a specificity of 1.000 (95% CI, 1.000-1.000). In the CSMC test cohort, moderate or severe TR was detected with an AUC of 0.928 (95% CI, 0.913-0.943), and severe TR was detected with an AUC of 0.956 (95% CI, 0.940-0.969). In the SHC cohort, the view classifier correctly identified at least 1 TR color Doppler video in 5268 of the 5549 studies, resulting in an AUC of 0.999 (95% CI, 0.998-0.999), a sensitivity of 0.949 (95% CI, 0.944-0.955), and a specificity of 0.999 (95% CI, 0.999-0.999). The artificial intelligence model detected moderate or severe TR with an AUC of 0.951 (95% CI, 0.938-0.962) and severe TR with an AUC of 0.980 (95% CI, 0.966-0.988). Conclusions and Relevance In this study, an automated pipeline was developed to identify clinically significant TR with excellent performance. With open-source code and weights, this project can serve as the foundation for future prospective evaluation of artificial intelligence–assisted workflows in echocardiography.